For survivors of catastrophic motor vehicle crashes in Michigan—individuals battling severe traumatic brain injuries (TBI), spinal cord transections, paraplegia, and multiple amputations—the most essential benefit provided under the Michigan No-Fault Act is Attendant Care.

Codified under MCL 500.3107(1)(a) as an “allowable expense,” attendant care pays for in-home nursing and personal aide services required to keep severely disabled victims alive, dignified, and safe in their own homes rather than institutional nursing facilities.

Historically, family members—spouses, parents, and adult children—quit their careers to provide round-the-clock, 24/7 care for their injured loved ones, compensated by auto insurers at fair market rates.

However, Michigan’s contentious 2019 No-Fault auto insurance reforms enacted a controversial statutory ceiling: the 56-hour weekly limit on family-provided care (MCL 500.3157(10)).

The reform ignited intense legal warfare, culminating in the Michigan Supreme Court’s landmark ruling in Andary v. USAA Casualty Insurance Co.

This comprehensive legal guide analyzes the current statutory attendant care rules for 2026, explains who is exempt under the Andary decision, details current hourly reimbursement rates, and outlines how catastrophic crash victims can secure full round-the-clock coverage.

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1. The 56-Hour Family Rule: What Does the Statute Mandate?

Under Section 3157(10) of the Insurance Code, the legislature created an aggressive restriction aimed at curbing insurance payouts:

“An insurer is only required to pay an attendant care benefit for more than 56 hours per week if the care is provided by an individual who is not a family member, household member, or individual with whom the injured person had a relationship before the injury.”

How the Cap Operates in Practice

If a catastrophically injured auto accident victim requires 24 hours per day of continuous supervision (168 hours per week): * The patient’s spouse, mother, or children can only be paid for a combined total of 56 hours per week (an average of 8 hours per day). * The remaining 112 hours per week cannot legally be billed by family members. * To obtain care for those remaining 112 hours, the family must bring strangers—outside nurses or commercial agency aides—into their private home, or the family must provide the remaining 112 hours completely uncompensated.

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2. The Landmark Andary v. USAA Supreme Court Verdict

The human cost of the 2019 reform triggered immediate constitutional litigation led by brain injury survivor Ellen Andary, quadriplegic Philip Krueger, and the Eisenhower Center rehabilitation facility.

In July 2023, the Michigan Supreme Court issued a definitive 5-2 ruling in Andary v. USAA Casualty Insurance Co. (Docket No. 164741):

                       DATE OF MOTOR VEHICLE ACCIDENT
                                     │
            ┌────────────────────────┴────────────────────────┐
            ▼                                                 ▼
[ACCIDENT PRIOR TO JUNE 11, 2019]            [ACCIDENT ON OR AFTER JUNE 11, 2019]
            │                                                 │
            ▼                                                 ▼
• 100% EXEMPT from 56-hour cap.             • 56-hour family cap FULLY APPLIES.
• 100% EXEMPT from fee schedule cuts.       • 45% fee schedule cuts FULLY APPLY.
• Retains unlimited family care hours.       • Must use commercial agencies >56 hrs.

The Legal Doctrine of Vested Rights

Justice Elizabeth Welch wrote that individuals injured before the reform legislation took effect had a “vested contractual right” under their insurance policies to lifetime unlimited allowable expenses. The court ruled that applying the 2019 restrictions retroactively violated the Michigan Constitution.

However, for any motorist injured on or after June 11, 2019, the 56-hour family cap remains fully enforceable law.

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3. Hourly Reimbursement Rates: What Can Family Caregivers Collect?

Under Michigan law, family members providing attendant care are entitled to receive the reasonable market value of their services.

Determining Hourly Rates

Because family members rarely have standardized commercial billing fee schedules, insurers evaluate rates under MCL 500.3157: 1. Uncertified Family Care (Basic ADLs): Assistance with bathing, grooming, dressing, meal preparation, and transfers typically reimburses at $18.00 to $24.00 per hour. 2. High-Tech Aide Care (Complex Needs): Managing bowel and bladder routines, administering subcutaneous injections, operating Hoyer lifts, and managing tracheostomies typically reimburses between $25.00 and $32.00 per hour. 3. Licensed Family Nurses (LPN / RN): If the family member holds a valid nursing license and provides skilled clinical care, rates can reach $40.00 to $55.00 per hour.

Note: Attendant care income received by family members caring for an injured relative is generally subject to federal and state income tax unless structured through specific Medicaid home-care difficulty-of-care tax exclusions under IRS Notice 2014-7.

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4. How to Overcome Insurance Denials for 24/7 Care

Auto insurance claims adjusters routinely contest the necessity of round-the-clock care, arguing that family members are merely providing “ordinary household chores” rather than medical attendant care:

Essential Evidence Checklist for Claim Approval:

• The Attending Physician’s Script: The doctor must prescribe attendant care with exact specificity: e.g., “Patient requires 24 hours per day, 7 days per week of skilled continuous attendant care for safety, fall prevention, and aspiration precautions due to severe traumatic brain injury.” A generic note stating “needs assistance at home” will be immediately rejected.
• Functional Capacity Evaluations (FCE): Comprehensive assessments by licensed Occupational Therapists demonstrating that the patient cannot be left unattended for even 15 minutes due to cognitive impulsivity, seizure risks, or lack of physical mobility.
• Detailed Contemporaneous Care Logs: Caregivers must maintain daily written timecards detailing hour-by-hour care: recording medication times, repositioning schedules (to prevent decubitus bedsores), hygiene assistance, and cognitive redirection.

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5. Working Around the 56-Hour Limit: Agency Contracting

For post-2019 crash victims who need care beyond 56 hours per week, families have two primary lawful options:

1. Direct Agency Placement: Contract with an accredited, third-party Michigan home health care agency. The agency bills the auto insurer directly for the remaining 112 hours per week and sends outside caregivers into the residence.
2. Family Employment by Commercial Agency: In some instances, an outside commercial agency will hire the family caregiver as an official employee on their payroll. The agency assigns the family member to cover the initial 56 hours and assigns independent staff to cover the remaining night and weekend shifts, ensuring the patient receives 24/7 coverage while remaining compliant with state law.

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Frequently Asked Questions (FAQ)

What is the 56-hour attendant care rule in Michigan?

Under Section 500.3157(10) of the Michigan Compiled Laws, auto insurance companies are only legally required to pay for up to 56 hours per week of in-home attendant care provided directly by family members, household residents, or persons with whom the injured individual had a pre-accident relationship. Any hours beyond 56 per week must be provided by an outside, licensed commercial home care agency.

Did the Michigan Supreme Court strike down the 56-hour attendant care cap?

In the landmark 2023 ruling Andary v. USAA Casualty Insurance Co., the Michigan Supreme Court ruled that the 56-hour family cap and medical fee schedules cannot be applied retroactively to individuals injured in auto accidents prior to June 11, 2019. However, for crashes occurring on or after June 11, 2019, the 56-hour weekly family caregiver restriction remains active statutory law.

How much does Michigan auto insurance pay family members for attendant care?

Under current DIFS guidelines and fee schedule formulas, family attendant care hourly rates typically range from $18.00 to $32.00 per hour for high-tech aide care, depending on geographic market rates, the patient’s level of acuity, and whether the caregiver holds formal CNA or nursing credentials. Commercial agencies bill higher rates, often between $35.00 and $65.00+ per hour.

Can a family member form an LLC to get around the 56-hour limit in Michigan?

Historically, some families formed independent home care companies to avoid the cap. However, Michigan insurance carriers aggressively challenge these arrangements. Under statutory definitions, if the care is provided by family or in the home by persons with a prior relationship, insurers apply the 56-hour cap regardless of whether a corporate LLC entity was created, unless the company is an accredited commercial agency employing outside non-family staff.

How do you prove the need for 24-hour attendant care to an insurance adjuster?

Securing 24/7 attendant care requires: (1) A detailed Prescription for Attendant Care signed by the patient’s attending physiatrist, neurologist, or trauma physician specifying the exact number of hours needed daily; (2) An Independent Neuropsychological or Occupational Therapy Evaluation detailing deficits in Activities of Daily Living (ADLs); and (3) Daily contemporaneous care logs documenting specific tasks performed (transfers, hygiene, medication management, aspiration precautions).